Small babies Flashcards
Factors used to calculate the optimal weight of a newborn:
Gestational age Mothers weight and height Fetal gender Parity Ethnic group Altitude
A bigger baby may be:
Male
2nd baby
Larger mother
Size vs Growth
Size = one measurement Growth = multiple measurements
After 40 weeks the placenta …
gets older, can slow growth
Baby’s growth slows or stops during pregnancy =
Intrauterine growth restriction
Dangers for bigger babies:
Can’t be delivered
Diabetic - may be hypoglycemic
Dangers for smaller babies:
Hypoperfusion inside uterus
Morbidity of small babies:
Birth asphyxia Mechanical aspiration Hypoglycaemia Hypothermia Long-term problems
Mortality of small babies is related to:
Getational age
Severity of IUGR
Cell growth at 0-14 weeks:
Hyperplasia
Cell growth at 16-32 weeks
Hyperplasia and hypertrophy
Cell growth at 32 weeks +
Hypertrophy and fat deposition
Depending on the time of the insult, growth restriction can be:
Symmetrical
Asymmetrical
Symmetrical growth restriction:
Early insult
Asymmetrical growth restriction:
Later insult
Early/symmetrical growth restriction:
Effects number and size of cells. Proportional reduction.
Decrease in abdo and head circumferences
Late/asymmetrical growth restriction:
Affects cell size, reduces fat deposition and liver size. Decrease in abdomen greater than head.
Ex of causes of symmetrical IUGR
Infection/Viral
Chemical exposure
Chromosomal
Ex of causes of asymmetrical IUGR
Pre-ecclampsia
Placental insufficiency
4 causes of fetal growth restriction:
- Maternal
- Fetal
- Placenta
- Uterine
Maternal factors:
Smoking
Alcohol
Anaemia
Medical disease: CVD, renal, hypertension
Fetal factors:
Structural abnormalities
Chromosomal abnormalities
TORCHS infections
TORCH:
Toxoplasmosis Rubella CMB Herpes Syphillis
Placental factors:
Abruptio placenta Placenta praevia Infarction Vasculitis Calcification Umbilical abnormalities
Abruptio placenta:
Placenta detaches from fetus early
Placenta privia
Placenta lies over cervix/low in uterus
Why may a placenta be big?
Multiple gestations
Big baby
Diabetes
Chorangioma:
Non-neplastic haematoma like growth in placenta
Uterine factors:
Decreased uterine blood flow
Pre-exlampsia
Atherosclerosis of uterine spiral arteries
What may decrease uterine blood flow:
Uterine fibroids
How to screen/diagnose IUGF:
Clinical
Biochemical
Ultrasound
Doppler analysis
Clinical measurements of IUGF:
Fundal height
RIsk assessment
Biochemical measurements:
Look at placental hormones to detect poor placenta function (HPL, oestradiol, HCG)
Ultrasounds measure:
Abdominal circumference
Head circumference
Femur length
Liquor volume
Doppler analysis should be used when
Abnormal ultrasound
Doppler looks at:
Umbilical artery. Can detect whether hypoxic and acidotic
Treatment before 34 weeks:
Steroids
Serial scans and dopplers
CTG
Treatment after 34 weeks:
Deliver
Bakers hypothesis describes:
Fetal programming arising from impaired growth in pregnancy and infancy
Increased risk of what in the long term?
Adult metabolic syndrome:
- hypertension
- type 2 diabetes
- stroke
- ischemic heart disease
